Provider Demographics
NPI:1255846556
Name:RENOVAR STEM CELL LLC
Entity Type:Organization
Organization Name:RENOVAR STEM CELL LLC
Other - Org Name:PRECISION DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-929-5600
Mailing Address - Street 1:2300 GLADES RD STE 430W
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-8533
Mailing Address - Country:US
Mailing Address - Phone:561-929-5600
Mailing Address - Fax:561-757-7055
Practice Address - Street 1:2300 GLADES RD STE 430W
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8533
Practice Address - Country:US
Practice Address - Phone:561-929-5600
Practice Address - Fax:561-757-7055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENOVAR STEM CELL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies